Hypertonic saline in critical illness - A systematic review.

Publisher: W.B. Saunders Country of Publication: United States NLM ID: 8610642 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1557-8615 (Electronic) Linking ISSN: 08839441 NLM ISO Abbreviation: J Crit Care Subsets: MEDLINE

Publication: Philadelphia Pa : W.B. Saunders
Original Publication: Orlando, FL : Grune & Stratton, c1986-

Fluid Therapy*/methods ; Resuscitation*/methods; Critical Illness/*therapy ; Hypovolemia/*therapy ; Isotonic Solutions/*therapeutic use ; Rehydration Solutions/*therapeutic use ; Saline Solution, Hypertonic/*therapeutic use; Critical Illness/mortality ; Crystalloid Solutions ; Humans ; Hypovolemia/mortality

Introduction: The optimal approach to fluid management in critically ill patients is highly debated. Fluid resuscitation using hypertonic saline was used in the past for more than thirty years, but has recently disappeared from clinical practice. Here we provide an overview on the currently available literature on effects of hypertonic saline infusion for fluid resuscitation in the critically ill.
Methods: Systematic analysis of reports of clinical trials comparing effects of hypertonic saline as resuscitation fluid to other available crystalloid solutions. A literature search of MEDLINE and the Cochrane Controlled Clinical trials register (CENTRAL) was conducted to identify suitable studies.
Results: The applied search strategy produced 2284 potential publications. After eliminating doubles, 855 titles and abstracts were screened and 40 references retrieved for full text analysis. At total of 25 scientific studies meet the prespecified inclusion criteria for this study.
Conclusion: Fluid resuscitation using hypertonic saline results in volume expansion and less total infusion volume. This may be of interest in oedematous patients with intravascular volume depletion. When such strategies are employed, renal effects may differ markedly according to prior intravascular volume status. Hypertonic saline induced changes in serum osmolality and electrolytes return to baseline within a limited period in time. Sparse evidence indicates that resuscitation with hypertonic saline results in less perioperative complications, ICU days and mortality in selected patients. In conclusion, the use of hypertonic saline may have beneficial features in selected critically ill patients when carefully chosen. Further clinical studies assessing relevant clinical outcomes are warranted.
(Copyright © 2017 Elsevier Inc. All rights reserved.)

Keywords: Critical illness; Crystalloid; Fluid; Resuscitation; Saline

0 (Crystalloid Solutions)
0 (Isotonic Solutions)
0 (Rehydration Solutions)
0 (Saline Solution, Hypertonic)

Date Created: 20170727 Date Completed: 20180917 Latest Revision: 20181202

20231215

10.1016/j.jcrc.2017.06.019

28746899